위 샘암종에서 CDX2와 Ets-1 발현

Abstract

Background: CDX2, a transcription factor expressed in the intestine, is an important regulator of intestinal differentiation, which could previously be identified in gastric carcinomas and intestinal metaplasia. Ets-1 protein is a transcription factor that has been implicated in both tumor invasion and angiogenesis. The purpose of this study was to evaluate the role of CDX2 and Ets-1 as a predictor for cancer progression and prognosis in gastric adenocarcinoma. Methods: Expression of CDX2 and Ets-1 was evaluated using immunohistochemistry in 163 primary gastric adenocarcinoma. The results were compared with both clinicopathological factors (age, sex, Lauren classification type, histologic grade, tumor depth, lymph node metastasis, distant metastasis and stage) and the overall survival. Results: CDX2 expression was positive in 93 cases (57.1%) and significantly correlated with intestinal type (p=0.02), shallower tumor depth (p=0.01), no node metastasis (p=0.02), lower stage (p=0.01) and longer survival rate (p=0.05). Ets-1 was not expressed in the normal gastric epithelium. Ets-1 expression was positive in 89 cases (54.6%) and significantly correlated with deeper invasion to wall (p<0.0001), lymph node metastasis (p<0.0001), higher stage (p<0.0001) and shorter survival rate (p<0.0001). In a univariate survival analysis, tumor depth, lymph node metastasis, stage, CDX2 and Ets-1 expression were independent predictors of patient outcome. Conclusion: These findings suggest that CDX2 may be involved in intestinal differentiation. The loss of CDX2 expression and Ets-1 expression may play a role in the tumor invasion and lymph node metastasis. The CDX2 expression may be associated with good prognostic marker and Ets-1 expression may be associated with poor prognostic marker. Therefore, CDX2 and Ets-1 expressions are a useful marker for predicting the outcome for patients with gastric adenocarcinoma.